{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:10:10Z","timestamp":1792789810078,"version":"4.5.0"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Malnutrition\u2019s prevalence and its relationship with functional ability in patients with end-stage spine pathologies, i.e., any disease of the vertebral bodies, intervertebral discs, and associated joints requiring surgical intervention, are yet to be explored. This retrospective study aimed to investigate the association between malnutrition, disability, and physical health in patients undergoing elective spine surgery in our Italian hospital. Materials and Methods: Data between 2016 and 2019, recorded at pre-admission visits, were extracted from our institutional spine registry (ClinicalTrials.gov number: NCT03644407), excluding minor patients or those undergoing emergency or oncological surgery. The measures were the Oswestry disability index (ODI) and the physical health (PH) summary of the 36-item Short-Form Health Survey. Clinical data were linked to nine laboratory parameters from pre-operative routine blood tests, and equations to ascertain the risk of malnutrition and its diagnosis were attributed. Results: The study sample included 2258 spine patients (58.15% females) who underwent surgery in our Italian hospital. The ODI and PH significantly varied across body weight difference (BWd) strata in younger adults (adjusted-p = 0.046, \u03b72 = 0.04; adjusted-p = 0.036, \u03b72 = 0.06) and adults (adjusted-p = 0.001, \u03b72 = 0.02; adjusted-p = 0.004, \u03b72 = 0.02). Protein malnutrition with acute\/chronic inflammation (PMAC) in both adults (adjusted-p &lt; 0.001, \u03b72 = 0.04; adjusted-p &lt; 0.001, \u03b72 = 0.04) and older adults (adjusted-p = 0.010, \u03b72 = 0.04; adjusted-p = 0.009, \u03b72 = 0.05) had also a discernible impact in determining the ODI and PH. In older adults, the ODI was associated with iron deficit malnutrition (IDM) (adjusted-p = 0.005, \u03b72 = 0.06) and both the ODI and PH were associated with vitamin B deficit (VBD) (adjusted-p = 0.037, \u03b72 = 0.01; adjusted-p = 0.049, \u03b72 = 0.01). Trend monotonicity was diagnosis- and sex-specific, with meaningful ordered patterns being observed mostly in young males and older females. Conclusions: Functional ability showed an association with malnutrition in younger adults and adults when using BWd, in adults and older adults when using PMAC, and in older adults when using IDM and VBD. The authors advocate for the inclusion of nutritional management in the pre-operative evaluation to potentially enhance recovery after spine surgery.<\/jats:p>","DOI":"10.3390\/medicina61030413","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T03:37:57Z","timestamp":1740627477000},"page":"413","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Malnutrition and Disability: A Retrospective Study on 2258 Adult Patients Undergoing Elective Spine Surgery"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0801-2359","authenticated-orcid":false,"given":"Matteo","family":"Briguglio","sequence":"first","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Laboratory of Nutritional Sciences, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Campagner","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Langella","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, GSpine 4, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Cecchinato","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, GSpine 4, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Damilano","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, GSpine 4, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4750-9077","authenticated-orcid":false,"given":"Pablo","family":"Bellosta-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Universidad San Jorge, 50830 Villanueva de G\u00e1llego, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziano","family":"Crespi","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9781-8607","authenticated-orcid":false,"given":"Elena","family":"De Vecchi","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Laboratory of Clinical Chemistry and Microbiology, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7932-0602","authenticated-orcid":false,"given":"Marialetizia","family":"Latella","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Laboratory of Nutritional Sciences, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-3055","authenticated-orcid":false,"given":"Giuseppe","family":"Barone","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Spine Unit 1, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6570-121X","authenticated-orcid":false,"given":"Laura","family":"Scaramuzzo","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli\u2014IRCCS, UOC Chirurgia Vertebrale, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4673-1020","authenticated-orcid":false,"given":"Roberto","family":"Bassani","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Spine Unit 2, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Luca","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Spine Unit 3, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Brayda-Bruno","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Spine Unit 3, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-2990","authenticated-orcid":false,"given":"Thomas W.","family":"Wainwright","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Institute, Bournemouth University, Bournemouth BH12 5BB, UK"},{"name":"University Hospitals Dorset, NHS Foundation Trust, Bournemouth BH7 7DW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Middleton","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Institute, Bournemouth University, Bournemouth BH12 5BB, UK"},{"name":"University Hospitals Dorset, NHS Foundation Trust, Bournemouth BH7 7DW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8365-985X","authenticated-orcid":false,"given":"Giovanni","family":"Lombardi","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Laboratory of Experimental Biochemistry and Molecular Biology, 20157 Milan, Italy"},{"name":"Department of Athletics, Pozna\u0144 University of Physical Education, Strength and Conditioning, 61-871 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4065-3415","authenticated-orcid":false,"given":"Federico","family":"Cabitza","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20157 Milan, Italy"},{"name":"Department of Computer Science, University of Milano-Bicocca, Systems and Communication, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9578-5338","authenticated-orcid":false,"given":"Giuseppe","family":"Banfi","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20157 Milan, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1891-3719","authenticated-orcid":false,"given":"Pedro","family":"Berjano","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, GSpine 4, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/00315125211059407","article-title":"Effects of Low Back Pain Exercises on Pain Symptoms and Activities of Daily Living: A Systematic Review and Meta-Analysis","volume":"129","author":"Zhang","year":"2022","journal-title":"Percept. Mot. Ski."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMp1707537","article-title":"Making Patients and Doctors Happier\u2014The Potential of Patient-Reported Outcomes","volume":"377","author":"Rotenstein","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1097\/BRS.0b013e3181aa1e6b","article-title":"Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study","volume":"34","author":"Monticone","year":"2009","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0895-4356(98)00094-8","article-title":"The Italian SF-36 Health Survey: Translation, validation and norming","volume":"51","author":"Apolone","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nagai, K., Komine, T., Ikuta, M., Gansa, M., Matsuzawa, R., Tamaki, K., Kusunoki, H., Wada, Y., Tsuji, S., and Sano, K. (2023). Decline of instrumental activities of daily living is a risk factor for nutritional deterioration in older adults: A prospective cohort study. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04185-6"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Briguglio, M., and Wainwright, T.W. (2023). The potential link between dietary factors and patient recovery in orthopedic surgery research. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1195399"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.clnesp.2023.07.083","article-title":"Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis","volume":"57","author":"Hu","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4061","DOI":"10.1111\/iwj.14297","article-title":"Association between malnutrition and surgical site wound infection among spinal surgery patients: A meta-analysis","volume":"20","author":"Xie","year":"2023","journal-title":"Int. Wound J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.jspd.2019.04.003","article-title":"The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery: A Systematic Review, Part 1","volume":"7","author":"Burton","year":"2019","journal-title":"Spine Deform."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108754","DOI":"10.1016\/j.clineuro.2025.108754","article-title":"Association of malnutrition with surgical outcomes after spine surgery for spinal epidural abscess","volume":"249","author":"Elsamadicy","year":"2025","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sunami, T., Miura, K., Shibao, Y., Okuwaki, S., Sakashita, K., Shimizu, T., Gamada, H., Noguchi, H., Takahashi, H., and Funayama, T. (2024). Surgical Apgar Score and Controlling Nutritional Status Score can be predictors of major postoperative complications after spine surgery. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-72202-8"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/2192568217708777","article-title":"Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery","volume":"8","author":"Phan","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Briguglio, M., Wainwright, T., and Lombardi, G. (2023). Definition of malnutrition from routinely-collected data for orthopedic surgery research: The global leadership initiative on malnutrition (GLIM) tool and others. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1200049"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bennette, C., and Vickers, A. (2012). Against quantiles: Categorization of continuous variables in epidemiologic research, and its discontents. BMC Med. Res. Methodol., 12.","DOI":"10.1186\/1471-2288-12-21"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_16","first-page":"613","article-title":"Tests for Departure from Normality. Empirical Results for the Distributions of b2 and \u221ab1","volume":"60","author":"Pearson","year":"1973","journal-title":"Biometrika"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/01621459.1965.10480811","article-title":"Some Tests for Homoscedasticity","volume":"60","author":"Goldfeld","year":"2012","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/biomet\/65.2.297","article-title":"On a measure of lack of fit in time series models","volume":"65","author":"Ljung","year":"1978","journal-title":"Biometrika"},{"key":"ref_19","first-page":"65","article-title":"A Simple Sequentially Rejective Multiple Test Procedure","volume":"6","author":"Holm","year":"1979","journal-title":"Scand. J. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1385-7258(52)50043-X","article-title":"The asymptotic normality and consistency of kendall\u2019s test against trend, when ties are present in one ranking","volume":"14","author":"Terpstra","year":"1952","journal-title":"Indag. Math."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/biomet\/41.1-2.133","article-title":"A Distribution-Free k-Sample Test Against Ordered Alternatives","volume":"41","author":"Jonckheere","year":"1954","journal-title":"Biometrika"},{"key":"ref_22","first-page":"779","article-title":"Support Vector Regression Machines","volume":"28","author":"Drucker","year":"1996","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6358624","DOI":"10.1155\/2018\/6358624","article-title":"\u201cBrave Men\u201d and \u201cEmotional Women\u201d: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain","volume":"2018","author":"Samulowitz","year":"2018","journal-title":"Pain. Res. Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1097\/j.pain.0000000000002866","article-title":"The burden of preoperative fear-avoidance beliefs in workers after thoracic and lumbar spine surgery: A 2-year follow-up study","volume":"164","author":"Langella","year":"2023","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1007\/s00586-018-5737-3","article-title":"Gender differences in degenerative spine surgery: Do female patients really fare worse?","volume":"27","author":"Siccoli","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_26","first-page":"11","article-title":"Understanding Perioperative Nutrition in Patients Undergoing Spine Surgery","volume":"81","author":"Saleh","year":"2023","journal-title":"Bull. NYU Hosp. Jt. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29S","DOI":"10.1177\/21925682231213799","article-title":"Malnutrition in Spine Oncology: Where Are We and What Are We Measuring?","volume":"15","author":"Goodwin","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1038\/oby.2007.223","article-title":"BMI, body composition, and physical functioning in older adults","volume":"15","author":"Woo","year":"2007","journal-title":"Obesity"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Caprariu, R., Oprea, M.D., Poenaru, D.V., and Andrei, D. (2023). Correlation between Preoperative MRI Parameters and Oswestry Disability Index in Patients with Lumbar Spinal Stenosis: A Retrospective Study. Medicina, 59.","DOI":"10.3390\/medicina59112000"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3369","DOI":"10.1007\/s00586-024-08364-w","article-title":"Impact of sarcopenia on outcomes following lumbar spine surgery for degenerative disease: An updated systematic review and meta-analysis","volume":"33","author":"Chen","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.nupar.2023.08.002","article-title":"Oral iron powder for prehabilitation in hip and knee arthroplasty: A randomized controlled trial to optimize hemoglobin concentration","volume":"37","author":"Briguglio","year":"2023","journal-title":"Nutr. Clin. M\u00e9tabolisme"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.jspd.2019.03.001","article-title":"The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery: A Systematic Review, Part 2","volume":"7","author":"Sethi","year":"2019","journal-title":"Spine Deform."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"45S","DOI":"10.1177\/2192568219882349","article-title":"Preoperative Maximization to Reduce Complications in Spinal Surgery","volume":"10","author":"Maitra","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e572","DOI":"10.1016\/j.wneu.2024.02.077","article-title":"Prognostic Nutritional Index and the Risk of Postoperative Complications After Spine Surgery: A Meta-Analysis","volume":"185","author":"Guo","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4328","DOI":"10.1007\/s00586-023-07930-y","article-title":"The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery","volume":"32","author":"Ryvlin","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"74","DOI":"10.22603\/ssrr.2022-0098","article-title":"Preoperative Malnutrition-Associated Spinal Malalignment with Patient-Reported Outcome Measures in Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study","volume":"7","author":"Wang","year":"2023","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1038\/s41430-021-00977-4","article-title":"Inflammation as a diagnostic criterion in the GLIM definition of malnutrition-what CRP-threshold relates to reduced food intake in older patients with acute disease?","volume":"76","author":"Pourhassan","year":"2022","journal-title":"Eur. J. Clin. Nutr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/413\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:33Z","timestamp":1760028213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["medicina61030413"],"URL":"https:\/\/doi.org\/10.3390\/medicina61030413","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]}}}